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Lacunar Infarcts Are the Main Correlate With Cognitive Dysfunction in CADASIL
Abstract
Background and Purpose— Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy is caused by mutations in the NOTCH3 gene and is clinically characterized by recurrent stroke and cognitive decline. Previous studies have shown an association between white matter hyperintensities on brain MRI and cognitive dysfunction in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. In the general population the presence of lacunar infarcts and microbleeds is also associated with cognitive dysfunction. The objective of this study was to determine to what extent lacunar infarcts and microbleeds on MRI contribute to cognitive decline in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. Methods— NOTCH3 mutation analysis was performed in 62 symptomatic and asymptomatic members of 15 cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy families. Neuropsychological tests were performed on the same day as the MRI examination. MRI was semi-quantitatively scored for white matter hyperintensities, infarct lesion load, and microbleeds. Regression analysis was performed to test the association between MRI abnormalities and neuropsychological test results. Results— Forty individuals had a NOTCH3 mutation and 22 did not. Severity of cognitive dysfunction in mutation carriers was independently associated with MRI infarct lesion load ( P <0.05). In contrast, WMH lesion load and microbleeds were not associated with cognitive dysfunction after correcting for age. Conclusions— Lacunar infarct lesion load is the most important MRI parameter associated with cognitive dysfunction in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.
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“As such, the burden of lacunes has been proposed as the most relevant MRI maker with regards to cognitive impairments in CADASIL [36, 40, 73].”
From Clinical and research applications of magnetic resonance imaging in the study of CADASIL (2019) · cites this paper as [40]
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“In contrast with WMH or CM, a larger volume of lacunes has been consistently linked with poorer clinical outcomes or cognitive performances in CADASIL patients [11, 36, 40, 50, 53, 59, 71, 73].”
From Clinical and research applications of magnetic resonance imaging in the study of CADASIL (2019) · cites this paper as [40]
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Small Fiber Pathology in CADASIL
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“In particular, the presence of lacunar infarcts is an important predictor of cognitive dysfunction and disability (Lee et al., 2011; Liem et al., 2007; Viswanathan et al., 2007).”
Wang, M., Li, Y., Song, Y., YingYu, Z., & Zhao, X. (2021) · Acta Radiologica · doi:10.1177/02841851211066583 · Cited by 4
Zhang, M., Xie, B., Gao, J., Mak, H. K., Kwong, A. S. K., Chan, D. C. P., & Cheung, R. T. F. (2019) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2019.06.028 · Cited by 5
Angiogenesis in the Central Nervous System
de Almodóvar, C. R., Zacchigna, S., & Carmeliet, P. (2008) · Springer eBooks · doi:10.1007/978-0-387-71518-6_42 · Cited by 5
Chui, H. C., & Ramirez-Gomez, L. A. (2016) · Wiley eBooks · doi:10.1002/9781118797662.ch4 · Cited by 4
Cavitation of symptomatic acute single small subcortical infarctions
Zhang, X., Ge, Y., Liang, C., & Wang, Y. (2020) · Neurological Sciences · doi:10.1007/s10072-020-04509-z · Cited by 3
Choi, J. C., Lee, J. S., & Kim, K. (2020) · Journal of Medicine and Life Science · doi:10.22730/jmls.2020.17.3.65 · Cited by 3
Bettcher, B. M., Bevan, C. J., & Geschwind, M. D. (2016) · Elsevier eBooks · doi:10.1016/b978-0-12-800105-9.00041-x · Cited by 3
SQSTM1 gene as a potential genetic modifier of CADASIL phenotype
Almeida, M. R., Silva, A. R., Elias, I., Fernandes, C., Machado, R., Galego, O., & Cordeiro, G. (2020) · Journal of Neurology · doi:10.1007/s00415-020-10308-5 · Cited by 3
Rounding up the usual suspects
Kalaria, R. N. (2007) · Neurology · doi:10.1212/01.wnl.0000271882.58578.61 · Cited by 3
Karvelas, N., Oh, B. C., Wang, E., Cobigo, Y., Tsuei, T., Fitzsimons, S., Ehrenberg, A. J., Geschwind, M. D., Schwartz, D., Kramer, J. H., et al. (2023) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2023.08.17.553732 · Cited by 3
NOTCH3 Mutations in CADASIL: a multicellular perspective on neurodegeneration
Lee, J. W. L., Ng, A. S. L., Tan, E., & Zeng, L. (2026) · Cell Communication and Signaling · doi:10.1186/s12964-026-02764-9 · Cited by 2
“…of CADASIL is the predominance of subcortical symptoms, including slowed processing speed, executive dysfunction, gait disturbance, mood changes, and apathy [31–33], with comparatively rare cortical manifestations such as aphasia, apraxia, or focal seizures, even in advanced disease [27, 34–36].”
Determination of Blood NOTCH3 Extracellular Domain and Jagged-1 Levels in Healthy Subjects
Kim, H., Jang, B. G., Kim, Y.-J., & Choi, J. C. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms231810547 · Cited by 2
CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy)
Rumboldt, Z. (2012) · Cambridge University Press eBooks · doi:10.1017/cbo9781139030854.023 · Cited by 2
Benisty, S., & Chabriat, H. (2020) · Springer eBooks · doi:10.1007/978-3-030-49586-2_7 · Cited by 2
Onodera, O., Sekine, Y., Kato, T., Koyama, A., Nozaki, H., & Nishizawa, M. (2014) · Neurology and Clinical Neuroscience · doi:10.1111/ncn3.134 · Cited by 1
A Japanese CADASIL kindred with a novel two‐base NOTCH 3 mutation
Suda, S., Okubo, S., Ueda, M., Sowa, K., Abe, A., Aoki, J., Muraga, K., Suzuki, K., Sakamoto, Y., Mizuta, I., et al. (2016) · European Journal of Neurology · doi:10.1111/ene.12977 · Cited by 1
“thermore, lacunar infarct load, but not WMH lesion load, is an important MRI parameter associated with cognitive dysfunction in CADASIL [7].”
BackgroundClinical Correlation of Magnetic Resonance Imaging Features of Cerebral Small Vessel Disease
Liu, D.-T., Liu, Y., Kong, Y.-Q., Zhou, L., & Hu, W. (2019) · World Neurosurgery · doi:10.1016/j.wneu.2019.02.099 · Cited by 1
Dowling, M. M. (2014) · Elsevier eBooks · doi:10.1016/b978-0-12-410529-4.00100-5 · Cited by 1
Lee, J. S., Ko, K., Oh, J., Choi, J. C., & Kim, J. (2018) · Journal of Medicine and Life Science · doi:10.22730/jmls.2018.15.2.89 · Cited by 1
Impact of Brain MRI Markers on Major and Mild Vascular Cognitive Impairment in CADASIL
Lee, J. S., Koh, M. J., Lee, H. K., & Choi, J. C. (2022) · Journal of the Korean Neurological Association · doi:10.17340/jkna.2022.1.5 · Cited by 1
CADASIL: a genetic model of arteriolar degeneration, white matter injury and dementia in later life
Salloway, S., Brennan-Krohn, T., Correia, S., Mellion, M. L., & DeLaMonte, S. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511581410.022 · Cited by 1
CADASIL: a genetic model of arteriolar degeneration, white matter injury, and dementia in later life
Goldfarb, D., Mellion, M. L., Salloway, S., Brennan-Krohn, T., Correia, S., & DeLaMonte, S. (2016) · Cambridge University Press eBooks · doi:10.1017/9781139924771.021 · Cited by 1
Molecular Genetics of Ischaemic Stroke
Floßmann, E. (2010) · Wiley eBooks · doi:10.1002/9780470015902.a0022411
Dalaker, T. O., Beyer, M. K., Stosic, M., & Zivadinov, R. (2009) · Springer eBooks · doi:10.1007/978-1-4020-9831-4_2
Confluent Thalamic Hyperintensities in CADASIL
de Médecine, F. (2010)
SÍNDROME CADASIL: EPIDEMIOLOGIA, CLÍNICA E
Correia, N. M. F. (2011)
NEUROIMAGEM CEREBRAL Com Imagem Ponderada Em Susceptibilidade
Lima, P. B., Freitas, D., Marques, C., & Rio, F. (2011)
Metadata
- Authors
- Liem, M. K., van der Grond, J., Haan, J., van den Boom, R., Ferrari, M. D., Knaap, Y. M., Breuning, M. H., van Buchem, M. A., Middelkoop, H. A. M., & Lesnik Oberstein, S. A. J.
- Affiliations
- Leiden University (NL)
- From the Departments of Radiology (M.K.L., J.v.d.G., R.v.d.B., M.A.v.B.), Clinical Genetics (M.H.B., S.A.J.L.O.), Neurology (J.H., M.D.F.), and Neuropsychology (Y.M.K., H.A.M.M.), Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology (J.H.), Rijnland Hospital, Leiderdorp, The Netherlands; Department of Psychology (H.A.M.M.), Neuropsychology unit, Leiden University, The Netherlands.
- Venue
- Stroke
- Published
- 2007-03
- Volume
- 38
- Issue
- 3
- Pages
- 923-928
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- OpenAlex
- W2061620398
- Cited by
- 114
- References
- 35
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 3 · 2023: 3 · 2022: 4 · 2021: 2 · 2020: 12 · 2019: 6 · 2018: 4 · 2017: 3 · 2016: 8 · 2015: 5 · 2014: 8 · 2013: 2 · 2012: 8
- FWCI
- 6.63
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Cerebrovascular and genetic disorders
- Health Sciences › Medicine › Clinical Neurology › Intracerebral and Subarachnoid Hemorrhage Research
- Life Sciences › Neuroscience › Neurology › Neurological Disease Mechanisms and Treatments
- Keywords
- CADASIL, NOTCH3 mutations, lacunar infarction, cognitive decline, white matter hyperintensities, microbleeds
- MeSH terms
- Receptor, Notch3, Adult, Cognition Disorders, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Mutation, Brain Infarction, CADASIL, Receptors, Notch
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